Hämodialyse

ZUSAMMENFASSUNG

Die Wahl des Dialyseverfahrens erfolgt auf der Basis eines umfassenden Aufklärungsgesprächs zwischen Arzt und Patienten über die individuellen Merkmale der einzelnen Verfahren und ihrer Eignung für den Patienten. Das medizinisch beste Nierenersatzverfahren ist die Nierentransplantation, die aus verschiedenen Gründen jedoch nicht immer durchgeführt werden kann. Zwischen den beiden apparativen Dialyseverfahren Hämo- (HD) und Peritonealdialyse (PD) gibt es keine größeren, evidenzgesicherten Unterschiede bzgl. Morbidität und Mortalität, sodass hier neben einigen Ein- und Ausschlusskriterien die Patientenpriorität berücksichtigt werden muss. Zu den Patientenmerkmalen und -wünschen gehören die Auswirkung auf die Alltagsgestaltung, Berücksichtigung der Restdiurese und evtl. seltene Ausschlussmerkmale bei der Zugangswahl. Da die PD in den ersten Jahren nach Dialysestart einen evtl. Mortalitätsvorteil bieten könnte, macht es bei voraussichtlich langer Dialyseabhängigkeit deshalb Sinn, eine „Nierenersatzkarriere“ mit der PD zu beginnen und HD-Verfahren erst später zu nutzen.

• Literatur

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